Cost Information for Physical Therapy

Dear Patient ,

It is our goal at Superior to provide as much transparency as possible as it relates to cost of services. Below is a list of items that we believe will help you understand what the costs will be while receiving services at Superior.

Cost is determined by your insurance policy physical therapy benefit, we do not control costs for our services.

Allowed Amount: Also known as the “negotiated rate” or “eligible expense” is the amount on your statement from the insurance company that the insurance company decides we will be paid for our services.

Patient responsibility: On your statement from the insurance company is the amount owed by the patient, determined by your insurance company.

The average allowed amount for an initial evaluation is between $95—165.00 depending on you plans coverage.

The average allowed amount for a treatment day is between $75.00 -- $124.00, again depending on your insurance type and rate they decide.

If you are uninsured OR we are out of network with your insurance company, we offer a self-pay rate of $90 per visit.

If your benefit has a yearly deductible this amount will be applied to it and you will be responsible until that deductible is met.

A copay or coinsurance often is applied once a deductible is met.

Some plans have a copay or a co-ins only benefit and does not apply to a deductible.

Please review your insurance verification form given to you at your initial evaluation. This form has your deductible and copay information on it.

Ever wonder about all the cost of health care? Here are some quick definitions and examples.

PREMIUM

A premium is the amount charged by insurance providers for coverage. Typically, this is paid monthly. You must pay your premium to remain covered by the insurance provider.

Here is an example….

You have researched health plans and rates and you have chosen one for $150.00 per month. In order to keep your benefits active, you will need to pay your premium on time every month.

DEDUCTIBLE

A deductible is a set amount you pay every year toward your medical bills before your insurance company begins paying. This will vary for every insurance plan.

Here is an example….

Your plan has a $1000 deductible. That means you will be required to pay your own medical bills up to $1000 for the year. Your insurance coverage will begin after the deductible is met. At the beginning of each year your deductible will reset.

COINSURANCE

Coinsurance is the percentage of your medical bill that you share with your insurance company after you have met your deductible.

Here is an example….

If you have an “80/20” plan, this means if your medical bill is $100 your insurance provider will pay $80 and you will be required to pay $20. Coinsurance is different and separate from any copayment.

COPAYMENT OR COPAY

Your copayment is a flat fee you pay every time you visit a medical professional or fill a prescription. It is usually a relatively small amount. Copayments do not count toward your deductible.

Here is an example….

You have plan that has a $20 copayment for Physical Therapy treatment. This means you must pay $20 each time you visit a Physical Therapy clinic. Copayments are different and separate from coinsurance.

Procedure Code

A procedure code is the medical code that we send to the insurance company to receive reimbursement for your visit.

Here is an example….

We see you for visit where we work on strengthening. We send the code 97140, that the insurance company reads as Manual Therapy Techniques. They then reimburse us the amount they see fit.

Allowed Amount

An allowed amount is the amount an insurance company will pay us for different Procedure Codes that we bill to them.

Here is an example….

You have Blue Cross Blue Shield insurance and we bill them for the code 97140, which is $90.00 worth of Manual Therapy Techniques. BCBS then tells us they will only pay $28.06 for that time.

Below are listed the procedure codes that we most commonly use during your sessions at Superior Physical Therapy. They indicate what type of treatment we are providing. Each type of treatment has a unique reimbursement that your insurance company has created. Each code is time dependent and differs based on the type of insurance. For example, Medicare uses a system where in a 40 minute session 3 codes are used. All other insurance companies use an 8 minute time for each code. Priority health is not code dependent and is a flat rate per visit.

Below are the codes and what treatments they stand for…

97140

is “Manual Therapy Techniques” like stretches that increase range of motion

97530

is “Therapeutic Activities” that are generally one-on-one patient contact that include exercises to increase strength.

97112

are “Therapeutic Procedures” that includes things like different exercises to improve balance or posture.

97110

are “Therapeutic Procedures” that includes things like different exercises to improve balance or posture.

97162 | 97163 | 97164

is an evaluation of an injury or issue causing the problem.

Now that you’ve got some of the lingo down, listed below are the top two insurance providers and the procedure codes we send to the providers. Also, listed is the amount of each procedure code that is charged to the insurance provider and the amount the insurance company actually pays us.

In the following charts you will find three columns, column one has the procedure code we use which dictates the treatment type during the time period you were with the therapist, column two is the amount we charged the insurance company (not the amount you owe or that we get paid), and column three is the amount that we get paid (allowed amount). We charge the insurance company more than they pay us because there are over 150 insurance companies we work with and the payment ranges significantly, however we can only submit one charge to all 150 companies.

By submitting this form, you are granting: Superior Physical Therapy, 3899 west front street unit 3, traverse city, Michigan, 49684, United States, http://www.thesuperiortherapy.com permission to email you. You may unsubscribe via the link found at the bottom of every email. (See our Email Privacy Policy for details.) Emails are serviced by Constant Contact.

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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. The purpose of this website is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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